S. Rutledge et al., CONSERVATIVE SURGERY FOR RECURRENT OR PERSISTENT CARCINOMA OF THE CERVIX FOLLOWING IRRADIATION - IS EXENTERATION ALWAYS NECESSARY, Gynecologic oncology, 52(3), 1994, pp. 353-359
Between 1960 and 1988, 47 patients had conservative surgery for postra
diation recurrent or persistent cervical carcinoma. Forty-two patients
with nonmetastatic disease and available follow-up information were d
ivided into 3 groups based on the extent of disease and type of surgic
al procedure. Group 1 contained 13 patients with smaller tumors prior
to radiation (FIGO Ib and IIa), and recurrent or persistent disease co
nfined to the cervix and/or vaginal vault. Group 2 consisted of 20 pat
ients presenting with more advanced disease than those in Group 1, at
the time of either radiation or surgery. Surgical resection of disease
was accomplished in both Groups 1 and 2 by either radical vaginal or
abdominal hysterectomy. The 8 patients in Group 3 required extended We
rtheim operations to encompass locally advanced disease involving the
bladder base and/or parametrium. One patient could not be categorized.
The 5-year estimated relapse-free survivals for each group were 84, 4
9, and 25%, respectively. The relapse-free survival of Group 1 was sig
nificantly better (P = 0.003) than that of Group 3. Major complication
s occurred in 4 patients belonging to Group 1 (31%), 10 in Group 2 (50
%), and 6 (including two treatment-related deaths) in Group 3 (75%). T
he most common complication was fistula formation in 11 patients (26%)
. Radical hysterectomy can be offered as an alternative to exenteratio
n in carefully selected patients. (C) 1994 Academic Press, Inc.